Development of HIV self-testing services through youth engagement: a qualitative evaluation of a health designathon in Nigeria

Abstract

Background: Providing a platform to engage young people as active participants and decision-makers in the design and delivery process of HIV testing efforts is critical to optimise uptake of HIV testing and other preventive services among this population. Designathon, an intensive team-based contest to crowdsource solutions, is a form of participatory approach that may increase the effectiveness of implementation strategies by fully engaging the end users in the design process. In this study, we explore strategies for HIV self-testing (HIVST) delivery developed at a designathon contest in Nigeria. Methods: The 48-h HIVST designathon held from March 29 to March 31, 2019, in Lagos state, Nigeria, occurred in three phases. First, we solicited solutions from Nigerian youth on how to encourage self-testing for HIV and other sexually transmitted infections in a way that is low-cost, accessible, youth-friendly and confidential. Second, submissions were shortlisted by an advisory committee and the top teams were invited to compete at the designathon contest. Third, the top teams presented their strategies using the business model canvas (BMC) to an expert panel. The BMC included: (1) description of the value of the HIVST service; (2) how and where to deliver HIVST; and (3) youth-friendly HIVST service strategies. Thematic analysis was used to explore key elements of the business model canvas. Findings: Of the 127 submissions received, 13 teams (with a total of 42 participants) were selected to participate at the designathon. Participants' median age was 22·5 years (IQR 21–24 years) and 28 (67%) were male. Teams developed segment-specific approaches such as online (ie, unstructured supplementary service data (USSD) services, gamification) and offline (ie, vending machines, community youth mobilisers) options for distributing and promoting the HIVST kit to reach a wider range of young people in both urban and rural settings. Multi-stakeholder partnerships at the local, state, and federal level were identified as key implementation mechanisms to drive scale-up and sustainability efforts. Interpretation: Designathons are a feasible method of facilitating meaningful youth engagement to develop deployable strategies to increase the uptake of HIV testing in young people in Nigeria. Additional refinement and rigorous evaluations of the proposed strategies in practice is an important next step to assess the effectiveness and impact of the models. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant number: 1UG3HD096929 and NIAID K24AI143471